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How does chemotherapy affect oral and dental health? In a variety of ways; however, it is important to note that the side effects typically resolve when patients end their treatment.

There are several oral side effects associated with chemotherapy. To oversimplify chemotherapy, chemotherapy interferes with the metabolism and reproduction of tumor cells, also known as neoplastic cells. In the process of altering the metabolism and reproduction of these cells, chemotherapy also affects other rapidly dividing cells in the body including the cells responsible for defending the body. In other words, chemotherapy affects the immune system. Typically, the side effects of chemotherapy discussed below are seen when the blood counts drop.

Oral mucositis

Oral mucositis, or more colloquially known as mouth sores, is a condition characterized by sloughing of the oral mucosa and the presence of red and white intraoral ulcers. It affects approximately 40% of patients undergoing chemotherapy. Traditionally, oral mucositis erupts two weeks after receiving high dose chemotherapy. Mucositis is most commonly seen on the movable tissues of the mouth (the cheeks, tongue, floor of the mouth, and the soft palate). Often it resolves when the blood counts recover.

How to treat/manage it

Prophylactic measures such as practicing good oral hygiene and avoiding spicy, hot, and acidic foods may help prevent the degree of mucositis experienced. Nonetheless, it is difficult to predict whether or not someone will experience oral mucositis as even those with impeccable oral hygiene may develop oral mucositis. However, it is important to note that practicing good oral hygiene and visiting a dentist prior to undergoing high dose chemotherapy has been associated with decreasing the duration of mucositis. There are several treatments that may help to alleviate the pain associated with mucositis including bland rinses, mucosal coating agents, and magic mouthwash.

Oral infections

Patients undergoing chemotherapy who are not on prophylactic medications may develop bacterial, fungal, and viral infections. The bacterial infections experienced may occur secondary to mucositis related ulcers. The viral infections that may occur usually resolve as the white blood cell count increases.

How to treat/manage it

These infections can all be controlled with appropriate medications. It is important to note that patients with fungal infections who wear dentures should also treat their dentures with an anti-fungal medication.

Neuropathy

Certain chemotherapies (such as vinca alkaloids) may result in neuropathies and mimic a toothache. Wait what?  Yes, that’s right. Certain chemotherapies can actually result in phantom tooth pain and throbbing lower jaw pain despite no evidence of dental decay or infection. These chemotherapeutic agents are also associated with peripheral neuropathy (tingling and loss of sensation of the fingers and toes). The neuropathy manifests differently in the jaw and results in the sensation of a toothache.

How to treat/manage it

It is important to visit a dentist for a thorough examination. Additionally, it is essential for patients to provide a thorough history of their cancer treatment to help determine the diagnosis of the tooth pain. The phantom toothache usually resolves within a week of completing the associated therapy.

Xerostomia/Hyposalivation

Xerostomia is the medical term for the sensation of dry mouth. Hyposalivation signifies a reduction in salivary flow and is an objective, measurable entity. In addition to reduced flow, the saliva produced is ropey, thick and predominantly mucus. As saliva acts as a natural buffer in the mouth, bathing and lubricating the teeth and oral tissues, reduced salivary flow leaves patients prone to an increased risk for dental decay. Additionally, xerostomia is associated with taste alterations, difficulty swallowing and difficulty speaking.

How to treat/manage it

Chemotherapy-associated dry mouth usually subsides when the therapy ends. Nonetheless, because dry mouth is associated with an increased risk for dental decay, it is important to visit the dentist regularly and to maintain excellent oral hygiene to help prevent cavities. Drinking water frequently, sleeping with a humidifier and rubbing olive oil on the oral tissues may also help alleviate the symptom of dry mouth. Other remedies include sucking on sugar-free lemon drops to promote salivary flow as well as several over-the-counter saliva substitutes.

Further Reading

Little, James W. Dental Management of the Medically Compromised Patient. St. Louis: Mosby, 2002. Print.

Oral Complications of Cancer Treatment: What the Dental Team Can Do. NIH, n.d. Web. 4 Dec. 2014.

“Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®.” National Cancer Institute. N.p., n.d. Web. 19 Nov. 2014.

Neville, Brad W. Oral and Maxillofacial Pathology. St. Louis, MO: Saunders/Elsevier, 2009. Print.

 

About Dr. Levi

As a general dentist with advanced training in dental oncology, Dr. Lauren Levi delivers comprehensive oral care to cancer patients in a warm, supportive, and gentle environment. After receiving her D.M.D. at the University of Florida College of Dentistry, Dr. Levi completed a general practice residency at New York Presbyterian-Weill Cornell Medical Center. During her residency, Dr. Levi rotated through Memorial Sloan Kettering Cancer Center, where she discovered her interest in dental oncology. She then pursued a fellowship in dental oncology at Memorial Sloan Kettering Cancer Center. This training equipped her with extensive experience performing dental treatment on patients who are receiving chemotherapy, radiation therapy, and stem cell transplants, and those who may face individual dental needs because of these treatment programs. For more information on dental oncology, visit http://laurenlevidmd.com.

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Susan started Savor Health after losing a close friend to a brain tumor and, through that experience, becoming aware of the significant unmet nutritional needs of people with cancer.  Struck by the fact that her friend was told “nutrition doesn’t matter” and “eat whatever you want,” Susan read the evidence-based literature on the subject, interviewed oncologists, oncology nurses and oncology dietitians, as well as patients and caregivers, and found that, in fact, nutrition does matter in oncology. Armed with solid scientific evidence supporting the clinical and quality of life benefits of proper nutrition, Susan left Wall Street and created Savor Health, an AI-based provider of personalized and clinically appropriate nutrition solutions for cancer patients, their caregivers and health enterprises. Susan brings to Savor Health over 25 years of industry experience in healthcare and business as well as expertise in strategy, finance and management.

Susan is an outspoken and tireless advocate for cancer patients receiving proper nutrition and nutrition support before, during and after treatment. She strongly believes that the U. S. healthcare system requires new innovation to transform it into a more holistic and integrated system of care whereby multiple disciplines coordinate care together for the benefit of the whole patient. As part of this, her goal is for nutrition to be an integral component of such an integrated cancer care delivery system.  Susan’s commitment to the field of oncology extends beyond Savor Health to volunteer work at Memorial Sloan Kettering Cancer Center in pediatrics and as a runner for Fred’s Team to raise money for research at Memorial Sloan Kettering. Susan participated in the Cancer Moonshot in June of 2016 where she was a breakout session group “igniter” tasked with starting and leading discussion. Susan’s first book, the Meals to Heal Cancer Cookbook, was published in March 2016.

In addition to her role as CEO of Savor Health, Susan speaks nationally about the importance of ensuring proper nutrition in the cancer patient and on topics including leadership and startups. She has been a speaker at the Harvard Medical School’s Career Advancement and Leadership Skills for Women in Healthcare, ESMO World Congress on GI Cancer, BioPharm America, AARP Live @50+, Lake Nona Impact Forum, and IIR ePharma Summit.

Prior to starting Savor Health, Susan had a successful career on Wall Street as a healthcare services investment banker working at prestigious firms including Donaldson, Lufkin & Jenrette, Wasserstein Perella and Robertson Stephens. Susan earned a B.A. from Duke University and M.B.A. from the University of Virginia’s Darden Graduate School of Business.

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Marissa Buchan is a registered dietitian, with advanced practice certifications in Oncology Nutrition (CSO) and Clinical Research (CCRP). She received her Bachelor’s degree in Psychology from Duke University, and Master’s of Science degree in Clinical Nutrition from New York University. Marissa worked for 10 years at Memorial Sloan Kettering Cancer Center in both the clinical research and nutrition departments.  In addition to counseling patients before, during, and after cancer therapy, she spearheaded nutrition-research efforts for the bone marrow transplant service. She has co-authored over 20 articles and has a particular interest in the role of nutrition on the intestinal microbiota and its impact on patient outcomes. When Marissa’s not wearing her lab coat, she’s in her apron whipping up healthy and delicious recipes that you can find on her blog, Get Off Your Tush and Cook.

Marissa is Chief Operating Officer of Savor Health where she leads operations working with the technology, clinical, and business development teams and management. Prior to assuming the role of COO in March 2020, Marissa was Vice President, Clinical Research and Operations at Savor Health where she worked closely with Savor Health’s Chief Medical Advisor, Scientific Advisory Board, and Clinical Operations Team to evaluate, design and conduct clinical research.  She also counsels patients on oncology nutrition issues and contributes to the Company website’s clinical content.

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Dr. DeFrance has a unique background including clinical interventional cardiologist, chief medical officer, educator, outcomes researcher and entrepreneur. He has expertise in Lifestyle medicine in which he was board certified in 2020 and is highly interested in the prevention and reversal of chronic disease. Dr. DeFrance also has expertise in appropriate utilization of technology in medicine, healthcare economics, value-based metrics, and educational design and delivery. He worked as Chief Medical Officer for HealthHelp, one of the largest specialty benefit managers in the US, and led large teams of healthcare professionals in writing evidence based appropriate care guidelines and rule sets which improve the quality and safety of medicine for over 20 million people in the US while also creating sustained savings in healthcare. He has also designed clinical decision support systems that are currently in use helping to improve patient care.

In 2018 Dr. DeFrance founded MedMentor Education, a company that provides state of the art CME content using the latest in eLearning science and online delivery platforms. Dr. DeFrance is also the founder and President of Digimedica, a consulting and educational design and delivery company for healthcare professionals, hospitals, and universities. He is passionate about creating systems to optimize knowledge transfer and has won numerous awards for teaching excellence during his career. He is an expert in cardiovascular CT imaging and has taught more than 3,000 physicians how to perform and interpret cardiac CT nationally and internationally and has lectured extensively on this subject.

Dr. DeFrance has a stellar reputation in the medical field and continues work to improve the quality and safety of patient care in the US.

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Alyson is a registered nurse and is certified in oncology nursing (OCN) through the Oncology Nursing Society (ONS). She also has her certification as an ONS Biotherapy and Chemotherapy Provider. Alyson studied nursing at Thomas Jefferson University where she obtained her Bachelor’s of Science in Nursing (BSN). Since starting her nursing career in 2004, Alyson has had a strong dedication and commitment to oncology patients. She has worked inpatient specializing in Bone Marrow and Peripheral Blood Stem Cell Transplantation. Alyson currently works in outpatient oncology at the North Shore-LIJ Monter Cancer Center. Alyson is part of the clinical team at Savor Health where she counsels patients on oncology and oncology nutrition issues and contributes to website and other Savor Health content.

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Chelsey is a Registered Dietitian and Board Certified Specialist in Oncology nutrition (CSO). She completed her Dietetic Internship at Northwell Health, received her BS in Dietetics at the University of Wisconsin-Madison, and her MS in Nutrition at Stony Brook University’s School of Medicine. Chelsey works as an outpatient dietitian at Mount Sinai covering all of the downtown cancer services at Mount Sinai Beth Israel and Philips Ambulatory Care Center. Chelsey works with patients and families before, during and after treatment to optimize their nutrition through dietary counseling and support. Chelsey has experience counseling clients with a variety of diagnoses including breast cancer, lung cancer, prostate cancer, head & neck cancer, and more. Chelsey also enjoys sharing nutrition knowledge with her peers by running a monthly Employee Wellness program that showcases healthy topics, recipes and food demos.

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Michelle is a Registered Dietitian specializing in oncology. She works as a clinical dietitian at an ambulatory cancer center in New York City and is a consultant for Savor Health. She is passionate about educating oncology patients on the importance of nutrition during their fight against cancer and helping them to optimize their nutrition through all phases of treatment. Michelle received her Bachelor of Science degree in dietetics from the University of Wisconsin-Madison and her Master of Science degree in Clinical Nutrition from New York University.

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Denise Sievering is a Registered Dietitian who is board certified in Oncology Nutrition as well as Nutrition Support. A fluent Spanish speaker, Denise joined the Savor Health team to support Spanish speaking cancer patients and to continue to expand the Platform’s nutritional strategies and recommendations in Spanish. Denise holds a Bachelor of Science degree from Rutgers University, and completed her internship at New York Presbyterian Hospital (NYP). Denise started her career as a registered dietitian at NYP-Columbia University Medical Center, primarily covering inpatient Oncology units. Denise also holds a Master of Arts degree in Mental Health Counseling from New York University, and incorporates her advanced training in motivational interviewing and empathic listening in her patient encounters, particularly those whose lives have been forever changed by a cancer diagnosis. A New Jersey native, Denise now resides in sunny San Diego, CA where she works as a part-time outpatient Oncology dietitian at Scripps Health-MD Anderson Cancer Center, and also works as an inpatient dietitian at Kaiser Permanente. In her spare time, Denise can be found at a mom-and-pop taco shop, one of the many local craft breweries, and exploring her new city of San Diego with her husband and her rescue pup, Ripley.

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Karen is a Registered Dietitian, Board Certified Specialist in Oncology Nutrition and registered in New York as a Certified Dietitian Nutritionist. Fluent in Spanish, Karen joined the Savor Health team to support Spanish speaking cancer patients and to continue to expand the Platform’s nutritional strategies and recommendations in Spanish. Karen received her Bachelor of Science degree from Ithaca College and her Master of Science degree from Hunter College. She works as an outpatient oncology dietitian in New York. Karen often works with local community centers to host nutrition programs for cancer survivors and their families, leading classes on how to live healthier lifestyles throughout their continuum of care. The American Institute of Cancer Research selected to showcase one of her many programs at their conference in 2019. Karen has written for and lent commentary to various publications and truly enjoys teaching people how to eat better. She loves to cook and strongly feels that healthy food doesn’t have to taste bad.

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Allie is a Registered Dietitian and a Certified Specialist in Oncology (CSO). She joins Savor in 2023, bringing years of experience from the John Theurer Cancer Center in New Jersey, where she worked with patients with a variety of cancers. Her goal is to help people feel their best, both mentally and physically, when physical health challenges arise. She believes in the power of nutrition ever since the impact it made on her athletic career as a volleyball player during college. Allie graduated with her Bachelor of Science degree from University of Maryland-Baltimore County and has her Master’s degree in Human Nutrition from the University of Wisconsin Stout. She enjoys travelling, enjoying different cuisines, cooking, and hiking and other outdoor activities with her family and dog.

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Julia Penberg is a seasoned healthcare professional with more than 30 years of experience focusing on maximizing operational excellence, leading clinical program development and building strong cross-functional teams. Her previous roles include overseeing the performance of clinical managers and nurse practitioners across multiple markets within United Healthcare-Optum’s Medicare Advantage and dual-eligible special needs populations, payer outreach and program development at Mayo Clinic, ground level specialty hospital development and direct patient care as a family and dermatology nurse practitioner. Julia volunteered as an operating room nurse and nurse practitioner on several mission trips to Romania and was a support group leader for the Kansas City chapter of the International Myeloma Foundation. Her motivation throughout her career has been with wellness promotion, disease risk modification and ensuring the best patient experience across the health continuum. Ms. Penberg received an MBA from the University of Dallas; a MS in Nursing from the University of Kansas and a BS in Nursing from the University of Texas-Austin. She is board certified as a Family Nurse Practitioner.

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Rachel is a Registered Dietitian and Board Certified Specialist in Oncology Nutrition (“CSO”). She joined NYP-Columbia as the outpatient oncology dietitian in 2020 after working at Jamaica Hospital Medical Center for two years. Rachel completed her dietetic internship through Keene State College in 2017. She is pursuing an MS in Integrative Nutrition at Stony Brook University and has a BS in Human Nutrition, Foods and Exercise from Virginia Tech. Rachel provides nutrition counseling to all types of oncology patients and helps them understand the mental and physical benefits of nutrition as an ally in their fight against cancer. In her free time she enjoys slow meals with family and friends, Pilates, and tending to her fire escape garden.

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Allie Werner is a Registered Dietitian at Fresenius Kidney Care where she provides medical nutrition therapy diet counseling to patients on Dialysis. She received her Bachelor’s Degree in nutrition from Indiana University and completed her Master’s Degree and dietetic internship at Loyola University Chicago. In her free time she enjoys spending time with friends and family, checking out the amazing food scene in downtown Chicago, and exercising on her Peloton bike.

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Immersed in the tech world for a decade, I've coded, led teams, and honed my skills in architecture and design. As a tech enthusiast, I've seamlessly woven through full-stack projects, fusing my love for code with the art of leadership.

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Mohit is a full-stack developer with expertise in Python and JavaScript, known for his efficient coding and ability to deliver scalable software solutions. His technical contributions are highlighted on GitHub and Stack Overflow, demonstrating his commitment to the tech community and problem-solving skills. With a solid educational foundation and a diverse project portfolio, Mohit excels at navigating complex challenges and is well-equipped to contribute to dynamic software projects.

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